Managing hypertension

Nada Hana Bachuri, MD

Nada Hana Bachuri, MD

Hypertension affects 85 million individuals, and 1 in 3 adults have high blood pressure in the United States. Blood pressure is the force of blood pushing against the walls of the arteries which carry blood from the heart to other parts of the body. In the United States, Hypertension is considered to be the most common primary diagnosis and reason for office visits. In addition, the prevalence is high, nationally and worldwide. In this article, we will identify Hypertension, briefly discuss causes, types, complications, and treatments.

Definition

The American Heart Association defines Hypertension as the following:

  •   Normal blood pressure: systolic < 120 mmHg and diastolic < 80 mmHg

  •   Elevated blood pressure: systolic 120-129 mmHg and diastolic < 80 mmHg

 

The European Society of Hypertension defines Hypertension as a systolic 140mmHg or diastolic 90mmHg.

 

Hypertension

  •   Stage 1 - Systolic 130mmHg - 139 mmHg or diastolic 80-89mmHg

  •   Stage 2 - Systolic 140mmHg or Diastolic 90mmHg

 

There are three important factors required to diagnose Hypertension:

1.      A proper measurement technique

2.      The integration of blood pressure measurement both at home using ABPM and clinical based readings

3.      A mean average calculated from taking multiple readings in order to accurately confirm the diagnosis

 

Types of Hypertension

1.      Primary Hypertension: unknown cause

2.      Secondary Hypertension

3.      Pregnancy induced Hypertension

 

How to properly measure the blood pressure

  •   Proper size cuff at mid-arm

  •   Sit with back supported

  •   Do not speak

  •   Rest arm at heart level

  •   Blood pressure should be measured in both arms and mean number should be taken

 

Primary (essential) Hypertension is the most common type. It is affected by cardiovascular and renal structure and function. Secondary Hypertension is caused by other conditions like tumors, hormonal dysfunction, structural anomalies, and pregnancy.

 

Risk factors of Hypertension

  •   Age: advancing in age increases the risk of Hypertension

  •   Using tobacco: smoking tobacco and chemicals in tobacco both causes damage and narrowing to the arteries

  •   Obesity: obesity and weight gain is a major contributing factor

  •   Family history: Hypertension is twice as common in individuals who have hypertensive parents. This could be related to genetics. Race also plays a role where Hypertension is higher in African Americans

  •   High sodium diet: excess sodium intake (>3g/ day sodium chloride) increases the risk of Hypertension

  •   Excessive alcohol consumption

  •   Physical activity: sedentary life style can cause Hypertension while increase in physical activity plays a major role in decreasing the blood pressure

  •   Medication: cold medicine and decongestants (phenylephrine and pseudoephedrine), oral contraceptives especially those with high estrogen, NSAIDs like ibuprofen, naproxen, especially for long use, steroids, some weight loss medication, antidepressants, stimulants like ADHD medications and some other antipsychotics and finally illicit drugs like methamphetamines and cocaine

 

Secondary Hypertension

  •   Obstructive Sleep Apnea: Hypertension is reversible once apnea is treated

  •   Primary aldosterone’

  •   Pheochromocytomatous

  •   Renovascular Hypertension

  •   Coarctation of Aorta, Cushing’s syndrome, thyroid diseases

  •   Pregnancy induced Hypertension, related to pregnancy period and in most cases, blood pressure normalizes after child birth

 

Symptoms

Most people with high blood pressure have no signs or symptoms even if blood pressure readings are high. It is discovered while doing a routine checkup or seeing a physician for an unrelated complaint. Few people may experience headaches, shortness of breath, nosebleeds, chest pain, flushing, or they are presented with life threatening emergencies.

 

Complications of Hypertension

Persistent untreated high blood pressure and or sudden rise in blood pressure can lead to the following complications:

  •   Left ventricular hypertrophy

  • Heart failure

  •   Aneurysms and ruptured aneurysms

  • Ischemic and hemorrhagic stroke

  •   Chronic kidney disease

  • Impaired memory and dementia

  •   Hypertensive retinopathy

 

Treatment

Life style modifications should be initiated with all patients such as: salt and sodium restrictions, smoking cessation, increase physical activity, avoiding over use of pain medication, minimizing alcohol consumption and weight management.

Medications are used to decrease and or prevent complications of Hypertension. It is not uncommon to use more than one medicine to achieve maximum control. Antihypertensive medications are: diuretics like HCTZ or Chlorthalidone, calcium channel blockers like Amlodipin, ACE inhibitors like Lisinopril or Ramapril, ARBs like Losartan and Valsartan, beta blockers as an add on like Atenolol and Metoprolol, other medications are also available.

In conclusion, Hypertension is a silent killer as it is often a symptomatic, therefore, annual. Being physical and paying attention to abnormal signs and symptoms in our body is important to diagnose and treat this disease. The ultimate goal of therapy is to reduce cardiovascular events and end organ damage.

Nada Hana Bachuri, MD is a doctor at Ascension Providence Rochester Hospital and Troy Family Care.